An Obamacare quandary

Medi-Cal, the federal and state health program for the poor, has 9.4 million recipients, and under the new federal health care law, it’s going to grow by at least another 300,000 by 2015.

Up to two million of the enrollees are part of expanded Medi-Cal, which is called Medicaid in other states.

But who will give them medical care?

Read about the projects of other 2014 California Health Journalism Fellows.

Many health care experts say there will be enough doctors to treat this growing population, but some of the experts aren’t so sure. They say the state’s supply of doctors is relatively fixed and patient demand will expand rapidly. A doctor shortage, many of them believe, is inevitable.

Exacerbating the scenario is the already reduced number of California doctors (57 percent) who will accept new Medi-Cal patients, according to a study published last year in the journal Health Affairs. That’s the second lowest rate after New Jersey.

Reimbursement rates, which are among the lowest in the nation, even though the state has arguably the highest practice costs anywhere in the country, are another hurdle. With physicians paid just $18 a visit for primary care services, many patients are already having a tough time finding access to quality medical care.

Yet without adequate payment to maintain and even attract more physicians, some say, Medi-Cal becomes an empty promise of coverage.

Increased reimbursements could help. Two California legislators just introduced bills that would restore funding cuts the state has made to Medi-Cal rates and improve the long term stability of the program by extending primary-care reimbursement rate increases that have been temporarily introduced under the Affordable Care Act.

We plan to explore this quandary of Medi-Cal patient access to doctors through a major story for the San Jose Mercury News and the Bay Area News Group that focuses on a handful of Bay Area residents who are part of the expanded Medi-Cal system, as well as physicians who will be impacted. Is the prognosis as bad as some say? Or are strong enough measures in place to avoid a backlog of patients in doctors’ offices? We’ll contrast their experience with the experience of longtime Medi-Cal recipients as a way of helping readers new to the Medi-Cal system better understand how to navigate its hurdles. We’ll seek to partner with a non-profit group to host community outreach events, particularly in low-income areas like West Oakland and East San Jose that feature doctors and patients adapting to the new reality.